Drugs for Muscle Spasm and Spasticity EAQ

What are the anticholinergic side effects of cyclobenzaprine ER [Amrix]? Select all that apply. A. Tachycardia B. Constipation C. Angioedema D. Urinary retention E. Myocardial infarction

A, B, D Cyclobenzaprine ER [Amrix] is a cholinesterase inhibitor that inhibits parasympathetic activity, thereby causing side effects such as tachycardia, constipation, and urinary retention. Angioedema and myocardial infarction are the adverse effects of cyclobenzaprine that would occur if a medication overdose is administered.

The healthcare provider orders diazepam [Valium] 5 mg IV every 8 hours. The medication available is diazepam [Valium] 5 mg/mL. How many mL will the nurse administer? Record your answer using a whole number.

1 mL

The patient has been prescribed tizanidine [Zanaflex] and complains of experiencing a dry mouth. What is the nurse's highest priority action? A. Instruct the patient to use sugar-free lozenges to moisten the mouth. B. Notify the healthcare provider; this is indicative of an anaphylactic reaction. C. Monitor the patient closely for additional unexpected side effects of the drug. D. Notify the pharmacist; the patient may be receiving too high a dosage of the drug.

A. Instruct the patient to use sugar-free lozenges to moisten the mouth. Dry mouth is an expected side effect of treatment with tizanidine [Zanaflex] and should not be considered to be indicative of anaphylactic reaction or an overdosage of the drug.

The nurse on an orthopedic unit routinely cares for patients receiving carisoprodol [Soma]. For which adverse effects should the nurse monitor these patients? Select all that apply. A. Risk of dependence B. Unusual hair growth C. Decreased renal function D. Drowsiness and sedation E. Decreased neutrophil count

A, D Carisoprodol is a centrally acting skeletal muscle relaxant and as such can produce generalized central nervous system (CNS) depression. These agents may also cause physical dependence when taken long term or in high doses.

Upon assessing a patient who is being treated for muscle spasms, the nurse finds that the patient has hypotension, dizziness, and nausea. What should the nurse infer as the reason for these complications in the patient? A. Overdose of baclofen [Lioresal] B. Overdose of neostigmine [Prostigmin] C. Overdose of orphenadrine citrate [Norflex] D. Overdose of pyridostigmine bromide [Mestinon]

A. Overdose of baclofen [Lioresal] Baclofen [Lioresal] is used for the treatment of muscle spasms. An overdose of baclofen would result in GABA and dominant cholinergic effects. Symptoms such as dizziness, nausea, and hypotension would be observed in patients as a result of an overdose of this medication. An overdose of neostigmine [Prostigmin] can cause a cholinergic reaction and result in symptoms of nausea, abdominal cramps, excessive salivation, and sweating. An overdose of orphenadrine citrate [Norflex] would cause excitement and severe confusion leading to coma and convulsions. An overdose of pyridostigmine bromide [Mestinon] would result in cholinergic crisis manifesting in symptoms such as extreme muscle weakness, sweating, and tearing.

The primary healthcare provider has prescribed cyclobenzaprine ER [Amrix] to a patient who has muscle spasms. After reviewing the patient's medical history, the nurse requests the primary healthcare provider to revise the prescription. Which finding would most likely be the rationale for the nurse's action? Select all that apply. A.The patient has asthma. B. The patient has peptic ulcers. C. The patient has hyperthyroidism. D. The patient has hepatic impairment. E. The patient has narrow-angle glaucoma.

C, E The administration of cyclobenzaprine [Amrix] may cause hypertension and tachycardia in a patient who has hyperthyroidism. This medication may also cause an increase in intraocular pressure and is therefore contraindicated in patients who have narrow-angle glaucoma. Pyridostigmine [Mestinon] may not be administered in patients who have conditions such as asthma, peptic ulcers, and hepatic impairment as the medication may aggravate these conditions.

The nurse caring for a patient who is prescribed diazepam [Valium] finds that the patient is taking an herbal therapy. Which instructions should the nurse provide the patient? Select all that apply. A. "Avoid consuming garlic." B. "Avoid consuming ginger." C. "Avoid consuming valerian." D. "Avoid consuming aloe vera." E. "Avoid consuming kava kava."

C, E Diazepam [Valium] is a skeletal muscle relaxant, which acts to depress the central nervous system (CNS). Herbs, such as valerian and kava kava, may potentiate CNS depression if consumed during the administration of diazepam. Garlic, ginger, and aloe vera do not interact with diazepam and are not contraindicated when a patient is prescribed diazepam; however, garlic may thin the blood, ginger may cause gastrointestinal distress, and aloe vera may cause abdominal cramps or diarrhea.

The healthcare provider orders dantrolene 3 mg/kg IV for a patient with ongoing malignant hyperthermia. The patient weighs 220 lb. The nurse should anticipate administering how many mg of dantrolene? A. 30 mg B. 150 mg C. 300 mg D. 726 mg

C. 300 mg

A patient with multiple sclerosis (MS) is participating in a rehabilitation program. The patient has just been started on baclofen [Lioresal] 5 mg three times a day to help manage spasticity. How will the baclofen interfere with rehabilitation activities? A. By causing gastrointestinal distress B. By impairing coordinated movements C. By reducing sensation in the extremities D. By producing drowsiness, lethargy, and blurred vision

D. By producing drowsiness, lethargy, and blurred vision Drowsiness, lethargy, and blurred vision are adverse effects of baclofen that initially make it difficult for the patient to participate actively in rehabilitation activities. These adverse effects are most common during the early phase of therapy but subside with continued use. These effects can be reduced by starting with a small dose and gradually increasing it.

Which skeletal muscle relaxant is also the drug of choice for treating malignant hyperthermia? A. Baclofen [Lioresal] B. Diazepam [Valium] C. Tizanidine [Zanaflex] D. Dantrolene [Dantrium]

D. Dantrolene [Dantrium] Dantrolene, a direct-acting skeletal muscle relaxant, is the preferred treatment for malignant hyperthermia. Malignant hyperthermia is a life-threatening syndrome that usually occurs when a general anesthetic is used with a neuromuscular blocking agent. It presents with muscle rigidity and profound temperature elevation.

The nurse is caring for a patient receiving dantrolene [Dantrium] for spasticity associated with multiple sclerosis (MS). Which laboratory test will be important in monitoring for a potential adverse effect of this drug? A. Albumin level B. Blood urea nitrogen (BUN) C. Complete blood cell count (CBC) D. Gamma-glutamyltransferase (GGTP)

D. Gamma-glutamyltransferase (GGTP) In large doses, dantrolene has been associated with fatal liver failure. Liver function tests, such as gamma-glutamyltransferase (GGTP), should be performed at baseline and periodically thereafter.

The patient is prescribed cyclobenzaprine ER [Amrix]. What information does the nurse include in medication teaching? Select all that apply. A. "Avoid the consumption of alcohol." B. "Avoid consumption of barbiturates. C. "Avoid administration of anesthetics." D. "Avoid administration of aminoglycosides." E. "Avoid consumption of tricyclic antidepressants."

A, B, E Cyclobenzaprine ER [Amrix] is a medication that acts as a central nervous system (CNS) depressant. The consumption of alcohol during the course of cyclobenzaprine therapy may result in severe CNS depression; therefore, the nurse should advise the patient who is prescribed cyclobenzaprine to avoid alcohol consumption. Concomitant administration of barbiturates and cyclobenzaprine may result in coma. The administration of tricyclic antidepressants along with cyclobenzaprine may also cause severe CNS depression; therefore, these medications should not be prescribed concurrently. Anesthetics and aminoglycosides do not interact with cyclobenzaprine and can be safely prescribed together.

The nurse is caring for a patient who has a spinal cord injury and who was administered dantrolene [Dantrium]. What are the necessary nursing interventions required for the patient? Select all that apply. A. Monitoring liver enzyme levels in the patient B. Asking the patient to stop the medication after 1 week C. Keeping atropine sulfate [Atropisol] readily available for the patient D. Observing the patient for side effects related to the central nervous system E.Administering the medication in intravenous (IV) undiluted form at a rate of 0.5 mg/min

A, D Dantrolene [Dantrium] is used to treat muscle spasticity in patients who have multiple sclerosis, cerebral palsy, and spinal cord injury. As dantrolene may cause an increase in liver enzyme levels, the nurse should continuously monitor these levels in a patient. Dantrolene causes central nervous system (CNS) depression, so the nurse should observe the patient for signs of CNS depression. This medication cannot be used for more than 3 weeks as it may cause hepatotoxicity. Atropine sulfate [Atropisol] is an antidote for pyridostigmine [Mestinon] and is not an antidote for dantrolene [Dantrium]. It is not necessary to keep the atropine sulfate [Atropisol] readily available. Dantrolene is administered orally at a dose of 25 mg/day and the dosage would gradually be increased.

Which statement made by a patient indicates a need for further discharge instruction about baclofen [Lioresal]? A. "I'm glad I can still have a glass or two of wine at dinner." B. "If I develop any difficulty urinating, I will call my physician." C. "I'll contact my healthcare provider when I feel I no longer need the medication." D. "I'll need to check with my healthcare provider before taking my allergy medications."

A. "I'm glad I can still have a glass or two of wine at dinner." Alcohol can intensify the central nervous system (CNS) depressant effects of baclofen; therefore, further instruction is needed if the patient states that it is okay to have wine at dinner. The statement regarding difficulty with urinating indicates that the patient understands that urinary retention is a potential side effect. Baclofen should not be discontinued abruptly, because this can lead to hallucinations, paranoid ideation, and seizures. Patients should discuss withdrawal of baclofen with their healthcare provider, because it should be done over 1 to 2 weeks. Allergy medications should be evaluated by the healthcare provider to determine whether they contain antihistamines, which intensify the depressant effects.

Which medication is used to treat spasticity? A. Baclofen [Lioresal] B. Diazepam [Valium] C. Mupirocin [Bactroban] D. Beclomethasone [Beclovent]

A. Baclofen [Lioresal] Baclofen [Lioresal] is a skeletal muscle relaxant that is used to treat spasticity in a patient who has multiple sclerosis, spinal cord injury, or cerebral palsy. Spasticity is caused when the upper motor neurons fail to exert an inhibitory effect on the lower motor neurons. Baclofen inhibits lower motor neuron activity and decreases spasticity in the patient. Diazepam [Valium] is used to relieve muscle spasms in a patient. Mupirocin [Bactroban] is a topical antibiotic medication. This antibiotic and other forms of antibiotics are not used to treat spasticity. Beclomethasone [Beclovent] is a corticosteroid inhalant and would not be an effective treatment for spasticity.

A patient is prescribed carisoprodol [Soma] for relief of muscles spasms. What does the nurse instruct the patient to avoid while taking carisoprodol? A. Beer B. Coffee C. Grape juice D. Orange juice

A. Beer Alcohol can cause central nervous system depression and should be avoided while taking carisoprodol [Soma]. There is no need to avoid coffee, grape juice, or orange juice while taking the drug.

A patient who has paraplegia reports muscle spasms. Which medication should the nurse expect the primary healthcare provider to prescribe for the patient? A. Diazepam [Valium] B. Azathioprine [Imuran] C. Mupirocin [Bactroban] D. Beclomethasone [Beclovent]

A. Diazepam [Valium] Muscle spasms are commonly associated with paraplegia or paralysis of the lower limbs. Diazepam [Valium] is a centrally acting muscle relaxant that is used to treat muscle spasms in a patient who has paraplegia; therefore, a nurse should expect a primary healthcare provider to prescribe diazepam to the patient. Azathioprine [Imuran] is an immunosuppressive medication, mupirocin [Bactroban] is a topical antibiotic medication, and beclomethasone [Beclovent] is a corticosteroid inhalant, all of which would not be prescribed to treat muscle spasms.

Which drug is the only muscle relaxant that acts directly on the skeletal muscle? A. Baclofen [Lioresal] B. Diazepam [Valium] C. Dantrolene [Dantrium] D. Cyclobenzaprine [Flexeril]

C. Dantrolene [Dantrium] Dantrolene [Dantrium] works directly on the skeletal muscle by suppressing the release of calcium from the sarcoplasmic reticulum to ease contractions. The remaining medications are centrally acting muscle relaxants that work by means of central nervous system depression. Baclofen [Lioresal] is considered a muscle relaxant that acts in the area of the central nervous system. Diazepam [Valium] is a type of barbiturate. Cyclobenzaprine [Flexeril] falls under the category of tricyclic antidepressants.

The nurse notes that a patient has taken an excessive dose of baclofen [Lioresal]. Which action does the nurse implement immediately? A. Comfort measures B. Seizure precautions C. Airway maintenance D. Antidote preparation

C. Airway maintenance An overdose of baclofen [Lioresal] can cause respiratory depression as a result of excessive central nervous system depression so the nurse has to maintain an open airway with the use of oxygen and a bag for ventilation. General supportive therapy and seizure therapy, including cardiac monitoring, gastric lavage, and fluid therapy, are instituted to maintain vital functions until the depressant effects of baclofen [Lioresal] wear off. An antidote to baclofen [Lioresal] does not exist. Although comfort measures are usually appropriate, the nurse's priority is the maintenance of vital functions.

Dantrolene [Dantrium] acts on the sarcoplasmic reticulum in the treatment of malignant hyperthermia. What does it help to block? A. Sodium B. Glucose C. Calcium D. Potassium

C. Calcium The heat in malignant hyperthermia results from the contraction of muscles, which are the product of a massive release of calcium from the sarcoplasmic reticulum. By acting at the sarcoplasmic reticulum to block the release of calcium, dantrolene [Dantrium] relaxes skeletal muscle and helps reduce the patient's temperature. Dantrolene [Dantrium] is not responsible for the release of sodium, glucose, and potassium.

The nurse is caring for a patient after total hip replacement on postoperative day 1. The nurse notes that the patient's urine is dark brown. The nurse should review the medication administration record for which medication? A. Baclofen [Lioresal] B. Carisoprodol [Soma] C. Methocarbamol [Robaxin] D. Cyclobenzaprine [Flexeril]

C. Methocarbamol [Robaxin] Methocarbamol may turn urine brown, black, or dark green; patients should be forewarned of this harmless effect.

The nurse is caring for a patient who has been diagnosed with multiple sclerosis. The healthcare provider opts to include baclofen [Lioresal] as part of this patient's treatment regimen. The nurse recognizes that this is an appropriate medication for this patient because the drug will treat which symptom? A. Muscle aching B. Muscle wasting C. Muscle spasticity D. Muscle deterioration

C. Muscle spasticity Baclofen [Lioresal] is a muscle relaxant that is used to treat the spasticity of the muscles that occurs with multiple sclerosis. It does not specifically address muscle aching nor deterioration of muscle tissue.

Which medication acts as an agonist at the presynaptic alpha 2 receptor site? A. Baclofen [Lioresal] B. Diazepam [Valium] C. Tizanidine [Zanaflex] D. Dantrolene [Dantrium]

C. Tizanidine [Zanaflex] Tizanidine promotes inhibition by acting as an agonist at presynaptic alpha 2 receptors. Dantrolene relieves spasm by suppressing release of calcium from the sarcoplasmic reticulum. Baclofen and diazepam promote inhibition by enhancing the effects of gamma-aminobutyric acid (GABA), an inhibitory neurotransmitter.

Administration of dantrolene [Dantrium] for the treatment of muscle spasticity is contraindicated in which patient? A. A patient with cerebral palsy B. A patient with a C6 spinal cord injury C. A patient experiencing malignant hyperthermia D. A patient with multiple sclerosis and underlying cirrhosis

D. A patient with multiple sclerosis and underlying cirrhosis Although dantrolene is effective for treating spasticity in multiple sclerosis, it is contraindicated in a patient with underlying liver disease. Dantrolene is useful for relieving muscle spasticity associated with spinal cord injury and cerebral palsy and, in intravenous form, for managing life-threatening malignant hyperthermia.

The nurse prepares to administer cyclobenzaprine [Flexeril] to a patient who has been in a motor vehicle accident (MVA). Which preadministration assessment is the nurse's priority in the evaluation of adverse effects of therapy? A. Muscle spasms B. Amount of bleeding C. Indicators of infection D. Level of consciousness

D. Level of consciousness The nurse compares the patient's level of consciousness after the administration of cyclobenzaprine [Flexeril] to the findings of the preadministration neurologic assessment to evaluate the adverse effects of the drug, which can cause significant sedation. However, because the patient was in a motor vehicle accident, a significant reduction in the level of consciousness or unresponsiveness warrants further investigation by the nurse to rule out increased intracranial pressure. The nurse assesses muscle spasms to evaluate the effectiveness of therapy because less muscle spasticity is expected after the administration of cyclobenzaprine [Flexeril]. Cyclobenzaprine [Flexeril] should have no effect on infection; as long as the spastic muscles are not bleeding, it should have no direct effect on bleeding.

The nurse is caring for a patient who has muscle spasms and who is prescribed orphenadrine citrate [Norflex]. After reviewing the medical history of the patient, the nurse requests that the primary healthcare provider revise the prescription. What is the reason behind this nursing action? A. The patient has asthma. B. The patient has peptic ulcers. C. The patient has hyperthyroidism. D. The patient has narrow-angle glaucoma.

D. The patient has narrow-angle glaucoma. Orphenadrine [Norflex] is a centrally acting muscle relaxant that is used to treat muscle spasms in a patient. As this medication increases intraocular pressure, it is not advised for a patient who has narrow-angle glaucoma; therefore, the nurse should request that the primary healthcare provider revise the prescription. A patient who has asthma and peptic ulcers should not be prescribed pyridostigmine [Mestinon] because its cholinergic action may aggravate the symptoms of bronchial asthma and peptic ulcers. The administration of pyridostigmine [Mestinon] to a patient who has hyperthyroidism may result in increased blood pressure.